Impact of previous macrolide use on invasive pneumococcal disease due to erythromycin-resistant serotypes in adults over 59 years of age

Abelardo Claudio Fernández Chávez,Luis García Comas,Luis Manzano Espinosa,Jesús María Aranaz Andrés,Jose Yuste Lobo,Octavio Corral Pazos De Provens

doi:10.1007/s10096-021-04368-2

Abstract

The major goals of the study were to describe the invasive pneumococcal disease (IPD) cases due to erythromycin-resistant serotypes and to evaluate the association between these cases and recent macrolide use in individuals aged over 59 years. We selected cases of IPD reported between 2007 and 2016 in persons aged over 59 years living in the Community of Madrid (CM). We followed the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The explanatory variables (age, sex, year of onset of symptoms, clinical presentation, serotypes, vaccination status) were taken from the Mandatory Notification System for Infectious Diseases System and from the Vaccination Information System. The cases were classified as either included in the 13-valent pneumococcal conjugate vaccine (PCV13) or not (nonPCV13). Associations between cases due to erythromycin-resistant serotypes and previous macrolide use (total, long and short-term) were adjusted with a logistic regression multivariate analysis. A total of 1,831 cases were identified, of whom 408 were erythromycin-resistant serotypes. PCV13 cases were associated with previous macrolide use (OR: 5.07), particularly long-acting types (OR: 8.61). NonPCV13 cases were associated with the use of total macrolides (OR: 3.48) and long-acting macrolides (OR: 4.26) suggesting that PCV13 did not reduce the IPD cases in patients with previous use of macrolides. Our results confirmed that previous macrolide consumption was associated with the presence of IPD due to erythromycin-resistant serotypes. The risk was higher with the use of long-term macrolides.

Highlights

Invasive pneumococcal disease (IPD) due to antibioticresistant serotypes is a serious public health problem that can affect to population of different age groups and with high morbidity and mortality rates in individual with risk factors [1].In addition to age, increased risk of invasive pneumococcal disease (IPD) in individuals with medical conditions leading to a state of immune deficiency must be highlighted [2, 3]
Previous use of macrolides increases the risk of cases of IPD due to erythromycin-resistant serotypes
These results are consistent with some other studies, such as a prospective Canadian surveillance study, which concluded that exposure to a class of antibiotics is the most important factor in predicting antimicrobial resistance of Streptococcus pneumoniae (SP) [24]

Summary

Introduction

Invasive pneumococcal disease (IPD) due to antibioticresistant serotypes is a serious public health problem that can affect to population of different age groups and with high morbidity and mortality rates in individual with risk factors [1]. In addition to age, increased risk of IPD in individuals with medical conditions leading to a state of immune deficiency must be highlighted [2, 3]. Not all the aforementioned factors are associated to a higher risk of IPD by resistant serotypes, and the relationship with previous antibiotic use is not fully understood [4,5,6]. Adequate antibiotic therapy is essential for reducing the morbidity and mortality of pneumococcal infections [7]. Some studies suggest that previous macrolide consumption is associated with the resistance of

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Conclusion